Improving the adequacy of preoperative radiographic imaging for total hip arthroplasty digital templating: A quality improvement project

Abstract

Background: Elective total hip replacements (THR) represent a cornerstone in enhancing patients' quality of life by providing effective pain relief, achieved through the optimization of biomechanical function by orthopaedic surgeons. The success of these procedures hinges on meticulous preoperative planning. Integral to this process is the utilization of up-to-date radiographs and digital templating software in preoperative planning, with accuracy contingent upon the control of various elements in hip radiography. Objective: Our primary objective was to evaluate radiograph adequacy for templating in our institution and establish local guidelines. Our secondary objective was to reduce unnecessary radiation exposure by minimizing repeat templating radiographs. Methods: Utilizing the National Integrated Medical Imaging System (NIMIS), a retrospective analysis was conducted on templating radiographs i.e. anteroposterior (AP) pelvis, from 103 consecutive total hip replacement series in our unit. Assessment criteria for adequacy included: calibration device usage, absence of pelvic rotation, radiographic centring on the pubic symphysis, adequate femoral visibility, and 10–15° internal hip rotation. Results were systematically analysed, leading to the formulation of fundamental templating guidelines presented in a poster. These guidelines were communicated to radiologists in our institution. A follow-up review of a further 103 patients assessed guideline implementation. Results: Templating radiography in our institution exhibited excellent overall adequacy, averaging 78 % during the project, with exclusive use of the KingMark® calibration device. A Chi-Square Test revealed a significant correlation (p = 0.4384) between interventions and radiograph adequacy, supported by a small but statistically significant effect size (Cramer's V = 0.12). A 67 % reduction in repeated radiographs occurred post-intervention. Conclusion: This study contributes to refining preoperative templating accuracy in hip arthroplasty, enhancing patient outcomes. Future initiatives include the development of a formal training program for surgeons, radiologists, and radiographers within our institution, with potential implications for national implementation.

Keywords

• Digital templating
• Quality improvement project
• Hip radiography